The stage (or extent of spread) of cervical cancer determines the treatment. Women who wish to become pregnant may choose different approaches than those who do not wish children. Surgery, radiation, and chemotherapy are all used to remove or kill the cancerous cells.
Several factors influence the effectiveness of treatment. Younger women (under the age of 40) fair better than older, and small tumor masses are easier to eliminate than are large. Cancer cells that express a protein called vascular endothelial growth factor (VEGF) on their surface do not respond well to chemotherapy.
Common Treatment Options
In the earliest stage of the cancer, when the abnormal cells are restricted to the surface of the cervix (called carcinoma in situ), the objective of treatment is to remove only the abnormal cells. This can be done by freezing (cryotherapy) or with a laser (laser therapy). Another procedure, called loop electrosurgical excision, uses an electrical current running through a small wire loop. If several layers need to be excised, a cone-shaped area of the cervix may be removed in a process called conization.
Early stages (I or II) are often treated with one of two surgeries. A total hysterectomy is used to removes the cervix and uterus, whereas a radical hysterectomy is used to remove the cervix and some surrounding tissue, the uterus, and part of the vagina. Sometimes the lymph nodes near the tumor are also excised. In some cases surgery can be avoided and conization is all that is needed.
Surgery can be combined with radiation, either given externally by a beam directed at the pelvic region, or internally by inserting a tube into the vagina and injecting a radioactive substance onto the cervix (this is also called brachytherapy. Women at high risk for cancer recurrence may be treated with chemotherapy (cisplatin (Platinol))
Treatment of later stages, when the cancer has spread to other parts of the pelvis, involves radiation with cisplatin-based chemotherapy. Other drugs, topotecan or hycamtin, are used in combination with cisplatin for treatment of late-stage cancer. Recurrent cancer is treated with topotecan, cisplatin, and radiation.
Radiation has several roles in cancer therapy. In addition to shrinking the tumor, it relieves pain, slows bleeding, and reduces the risk of recurrence following surgery.
Other Treatment Options
There are two less common surgeries for early-stage cervical cancer. In a salpingo-oophorectomy, the two fallopian tubes and ovaries are removed during a total or radical hysterectomy. Surgeons may also perform a radical trachelectomy in which the cervix, part of the vagina, and pelvic lymph nodes are removed. This is used for women who wish to become pregnant or who have small tumors.
Other chemotherapeutic approaches include 5-Fluorouracil, ifosfamide, and paclitaxel. Ongoing clinical trials are investigating the effectiveness of treatment with a combination of drugs, or new applications for existing anticancer medicines. For example, some trials are now evaluating the effectiveness of pemetrexed – a drug used to treat lung cancer – as a treatment for cervical cancer.